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Long Thoracic Nerve Injury
Aka: Long Thoracic Nerve Injury, Long Thoracic Nerve Palsy, Long Thoracic Nerve Lesion
- See Also
- Peripheral Nerve Injury
- Anatomy
- Long Thoracic Nerve forms from C5-7 nerve roots at the middle scalene Muscle
- Causes
- Direct blow to Shoulder
- Direct blow to pectoralis Muscle at rib 4-5 at nerve exit site
- Chronic repetitive overhead Shoulder traction (e.g. tennis, volleyball, swimming, baseball)
- Traction injury at the middle scalene Muscle
- Radical Mastectomy
- Symptoms
- Diffuse Shoulder or Neck Pain with overhead activity
- Signs
- Forward flexion weakness at Shoulder
- Scapular winging
- Diagnostics
- Nerve Conduction Studies and EMG
- Shoulder MRI
- Not typically indicated but may show supraspinatus and infraspinatus denervation changes
- Management
- Shoulder Range of Motion Exercises
- Prevents Frozen Shoulder and contractures
- Strengthen remaining Shoulder stabilizing Muscles
- Trapezius Muscles
- Rhomboid Muscles
- Levator ScapulaMuscle
- Surgery is rarely indicated
- Consider surgery for Penetrating Trauma with nerve transection
- Consider surgery for lack of improvement at 18 to 24 months
- Course
- Therapy leads to recovery times typically of 9-12 months (may require up to 2 years)
- References
- Neal (2010) Am Fam Physician 81(2): 147-55 [PubMed]
- Safran (2004) Am Sports Med 32(4): 1063-76 [PubMed]
- Silver (2021) Am Fam Physician 103(5): 275-85 [PubMed]